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145 Cards in this Set
- Front
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Differentiate Eye infections |
HSV keratitis - look for vesicles orbital cellulitis - fever, proptosis, decr EOM, bacterial sinusitus most common predisposing factor gonococcal conjunctivitis - copious, purulent d/c, neonates viral conjunctivits - copious watery d/c, adeno, swimming trachoma - follicular conjunctivitis, neovascularization (pannus) in cornea |
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Ddx depressed mood |
MDD: >2wks, SIGECAPS 5+, significant functional impairment adjustment d/o with depressed mood: stressor + functional impairment normal stress response: no functional impairment |
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Nerves in the leg |
femoral: anterior muscle, sensation to anterior thigh and medial leg tibial: post muscle and plantar flexion, sensation to leg and plantar foot obturator: medial muscle, sensation to medial thigh common peroneal: ant/lat leg muscle and sensation |
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ASCUS+ on Pap |
21-24: repeat pap 1yr 25+: HPV test HPV+, then colposcopy HPV-, repeat pap and HPV in 3yr |
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Cervical Screening |
<21: none 21-29: pap q3yrs 30-65: pap q3 OR pap+HPV q5 65+ or hysterectomy: none |
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infertile + hx of PUD --> next step? |
hysterosalpingogram to look for tubal patency |
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breast mass workup? |
<30 --> U/S --> biopsy if complex cyst/mass >30 --> U/S and mammogram --> biopsy if concerning |
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congenital heart dz that improves with squatting? |
ToF tet spells while feeding, DUSKY |
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decr murmur with squatting? |
HCOM (everything else has incr murmur with squat) |
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cardiac arrest, most important factor for prognosis? |
time to resuscitation ie. CPR, AED |
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rubella congenital vs. kids vs. older |
congenital: hearing loss, ID, vision, heart kids: coryza, conjunctivitis, kuplik spots, cephalocaudal spread of rash adults: same as kids + arthritis/arthalgia |
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FEV/FCV <70 + low DLCO FEV/FCV <70 + normal DLCO |
emphysema chronic bronchitis or asthma |
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FEV/FCV >70 + low DLCO FEV/FCV >70 + normal DLCO |
ILD MSK/neuromuscular dz |
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broad and waxy cast RBC cast WBC cast fatty cast muddy brown cast |
ESRD glomerulonephritis indicates WBC in kidney (pyelo, AIN) nephrotic ATN |
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most sensitive indicator for hypovolemia? |
BUN/Cr >20:1 = prerenal azotemia, most sensitive FENA not reliable if diurectics |
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pt with GERD/Barretts with new onset dysphagia? |
stricture: barium swallow symmetric narrowing adenoCA: barium swallow asymmetric narrowing |
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dacryocystitis hordeolum chalazion |
lacrimal sac infection, medial eye abscess, staph lid discomfort, chronic inflammation of meibomian gland, hard/painless lid nodule |
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diarrhea in AIDS |
crypto: CD4 <200, severe watery diarrhea, low fever micro/iso-sporidium: CD4<100, fever is rare MAC: <50, high fever, watery diarrhea CMV: <50, freq small vol diarrhea, hematochezia, abd pain |
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2 things can control confounding |
randomization and matching |
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spinous process very tender?? |
vertebral osteomyelitis |
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nephrotic range proteinuria + hematuria = |
MPGN IgG against C3 convertases causes persistent activation of alternate pathway |
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immune complex mediated kidney dmg |
lupus post-strep |
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anti-GBM? cell-mediated kidney dmg non-immunologic |
goodpasteurs crescentic aka RPGN HTN, DM |
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patient needs emergent surgery, on warfarin --> |
give FFP to reverse warfarin if not emergent, can reverse with vit K platelet >50k = ok for surgery |
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cystathione synthase def defective collagen production fibrillin 1 mutation fibrillin 2 mutation xxy |
homocysteinuria (downward lens dislocation) ehlers-danlos (hyperelastic) marfan arachnodactyly klinefelter (tall slender) |
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when to intubate in asthma pt? |
not responsive to nebs AMS no air entry into lungs, no wheezing aka signs of resp failure |
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complication of EBV? |
AIHA and thrombocytopenia airway obstruct from enlarged tonsils |
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bullae, erythematous rash, nikolsy sign+ |
staph scalded skin syndrome look for signs of staph --> golden yellow crusting of mouth |
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pathophys of tamponade? |
restrict venous return --> decr ventricular preload |
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lights criteria for pleural effusion |
exudative: pleural/serum prot >0.5 pleural/serum LDH >0.6 (or 2/3 upper limit of normal) infection, malig, PE transudative: nephrotic, CHF, cirrhosis |
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hypopigmented lesion, muscle atrophy, loss of sensation? |
leprosy skin biopsy, acid fast stain |
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fibromyalgia polymyositis polymyalgia rheumatic |
pain everywhere, labs normal proximal weakness, elevated CPK pain, elevated ESR, temporal arteritis |
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thiamine riboflavin niacin pyridoxine colbalamin |
The Rhythm Nearly Proved Contagious *note P = B5 is panthothenic acid |
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duodenal hematoma |
kids, usually some trauma resolve on own, tx with NGT and parenteral nutrition |
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COPD pt who gets sick now has CNS, GI, heart things |
think theophylline toxicity due to infection or medication |
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stethoscope on upper abd rock pt back and forth at the hips |
looking for gastric outlet obstruction
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kid who gets swollen all the time after infection, dental procedure, trauma |
hereditary angioedema C1 inhibitor def |
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angle closure glaucoma |
asian women eye pain, dilated pupil and unresponsive HA, n/v vision loss if untreated |
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dilated bronchials on CT (looks really gross, lots of holes) |
brochiectasismost common complication = hemoptysis, sometimes severe enough requiring embolization |
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decr Ca, incr PO4 elevated PTH |
renal dz dont make vit D = decr Ca kidneys suck = cant excrete PO4 PTH response |
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usually normal Ca, decr PO4 elevated PTH |
vit D def |
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bulimia vs. anorexia |
bulimia -normal/high BMI anorexia -low BMI both have binging aspects and body image things |
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binge eating |
just binge, no compensatory behavior |
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primary polydispia central DI nephrogenic DI --> water deprivation test |
--> urine concentrates --> does not, responds to desmopressin --> does not ,no response to desmo |
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NPH wet wobbly whacky pathophys? |
decr CSF absorption (not incr production) |
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cyanosis at birth |
think transposition or hypoplastic L heart |
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tinnitus and vertigo --> ASA OD |
mixed resp alk and metabolic acidosis low bicarb bc acidosis low CO2 bc resp alk (blow off) pH almost normal |
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sepsis term infants sepsis preterm |
GBS E coli |
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fire? smoke? |
think CN and CO toxicity tx with hydroxocobalamin or Na thiosulfate tx with O2 |
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ducts -fibrosis and stenosis ducts -decr quantity |
PSC PBC |
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vitiligo associated autoimmune dz? |
pernicious anemia thyroid dz DM1 (NOT DM2) |
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phenytoin OD Li OD |
looks like wernicke (nystagmus, gait, confusion) tremor, hyperreflexia, gait, seizures |
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s/p stent placement, now presenting with crushing chest pain |
most likely medication noncompliance of ASA and clopidegrol causing stent thrombosis |
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telangiectasia gynecomastia testicular atrophy palmar erythema |
cirrhosis! |
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screen for bladder CA? |
NEVER. even with pts at risk bc low incidence and poor PPV |
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most common heart thing in Downs |
complete AVSD (endocardial cushions do not merge) |
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recurrent UTI in kids? |
think urinary tract anomaly vesicouretaral reflux --> blunted calyx and parenchymal scarring posterior urethral valve (boys) |
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tx for human or dog bites |
augmentin |
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old man gets up to pee and passes out? |
situational syncope (autonomic dysregulation) |
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aplastic anemia thumbs bent, short, hypogonad hypo/hyper lesions, freckles auditory/ear things |
fanconi anemia (chromosomal breaks) tx with stem cell transplant |
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most common predisposing factor to bacterial sinusitis? |
viral URI |
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HR low, AV block, hypotension, wheezing what OD? |
beta blocker give fluids, IV atropine give glucagon if still hypotensive |
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volume down, hypernatremia what fluids? |
give NS slowly |
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prader wili angelman |
p for paternal, eat a lot, almond eyes, weak suck maternal, smiling/laughter |
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malaria PPX |
w/o p facipurum --> primaquine w/ chloroquin susceptible --> cholroquine w/ chloroquin resist --> mefloquine resist --> africa, southeast asia |
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bony pain + mixed lytic/sclerotic lesions on XR |
pagets incr ALKP, incr urine hydroxyproline Ca/PO4 usually normal most common cause of asymp incr ALKP |
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heparin but worsening clot? |
HIT thrombocytopenia + thrombotic state |
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vesiculoureteral reflux gold standard in dx? |
voiding cystaurethrogram any kid <1yr with 1st UTI --> renal US to r/o abnormalities |
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neimann pick (sphingomyelinase) tay sachs (beta-hexosaminidase A) |
both: lose motor milestones, cherry red macula NP: HSM, areflexia TS: no HSM, hyperreflexia |
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krabbe (galactocerebrosidase) gaucher (glucocerebrosidase) |
looks like NP but no cherry red or HSM anemia, decr platelets, HSM; no cherry red or HSM |
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pinworm -enterobiasis |
itchy butt at night scotch tape test+ tx with albendazole |
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benznidazole 1st line for? |
Chagas RBBB, cardiomyopathy megacolon, megaesophagus |
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ivermectin 1st line for? |
strongyloidosis hives + pulm sx |
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nodule, ulcerate, pearly rolled border, slow growing actinic keratosis, faster growing |
BCC -more common, no mets SCC -less common both at sun exposed areas |
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winged scapula pain with internal rotation after forceful abduction (blocking a shot) claw hand wrist drop, humeral midshaft fx |
long thoracic nerve axillary nerve ulnar nerve radial nerve |
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most common bug for osteo in kids |
staph NOT strep |
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pain out of proportion pain with passive motion numbness and tingling pulse 2+ dx? |
compartment syndrome To OR for emergent fasciotomy |
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pt with RA now with nephrotic syndrome |
abnormal protein amyloidosis |
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lead time bias observer bias selection bias |
incr survival time explained by earlier dx prior knowledge biases the observer (must blind) when proper randomization is not achieved |
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HTN stroke, hemiparesis |
BG/putamen most common site (internal capsule involvement) |
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MEN 1 MEN 2A (RET gene) MEN 2B (RET gene) |
parathyroid, pancreas, pituitary thyroid CA, pheo, parathyroid thyroid CA, pheo, neuroma/marfanoid |
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flank pain, hematuria, tetany, calcium oxalate crystals in urine what did he take? |
ethylene glycol tx with fomipezole |
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ETOH sx but eye involvement, gap+ ETOH sx but eye involvement, gap- |
methanol isopropyl ETOH |
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constipation in kids |
more fiber, less milk, laxatives, enema |
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kid with harsh holosystolic murmur at LSB |
VSD (most common congenital heart thing) small defects louder and close spontaneously large defects usually softer ECHO --> to determine how big |
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PAS+, Tdt+ |
ALL |
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rapid onset breast changes (erythema, edema, dimpling, nipple retraction, pain) |
inflammatory breast carcinoma mammogram, U/S, biopsy |
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intermenstrual spotting, no uterus enlargment |
endometrial polyps |
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firm painless LAD, old guy, hx of smoking |
concerning of lymph node mets if head/neck --> SCC |
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kid with gait problems, heart problems, LE problems |
freidrichs ataxia gaa repeat, chrom 9, AR |
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when to give tetanus IG |
when wound is severe/dirty AND unimmunized/uncertain vaccine hx |
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colonoscopy in UC pts |
start 8 yrs after dx, q1-2 years |
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smoker, sudden onset dyspnea |
spontaneous PTX from incr blebs due to COPD |
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biggest risk factor for pancreatic CA |
smoking, fat, family hx ETOH only minor incr |
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most common cause of aortic dissection? |
uncontrolled HTN |
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facial flushing with sun, ETOH, emotion, etc looks like malar rash of SLE but involves nasolabial folds |
rosacea |
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burn victim + compartment syndrome manage? |
escharotomy for eschar constriction |
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howell jolly bodies (blue inclusions on RBC) what does this indicate |
splenectomy or nonfunctional spleen |
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low IG's, normal B cells low IG's, low/absent B cells |
CVID bruton/x-linked agammaglobulinemia |
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rash low platelets recurrent infections what immune dz? |
wiskott aldrich (WA-TER) impaired cytoskeleton |
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immune deficient ataxia cancer what dz |
ataxia telangiectasia DNA repair defect |
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cat+ organisms abscesses, staph what immune dz |
chronic granulomatous disease cant make H2O2 |
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contact lens associated keratitis what bug? |
pseudo! looks gross, risk of corneal perf |
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lumbar stenosis |
back pain radiating to thighs worse with extension pain with walking aka neurogenic claudication |
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lumbar herniation |
hx of trauma/inciting event unilateral back pain radiating down one leg (sciatica) |
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injury, rapid decel or direction change "popping" sensation swelling, bloody joint effusion |
ACL tear +lachman and anterior drawer test |
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knee struck on lateral side (football tackle) swelling but no hamarthrosis |
MCL tear |
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chronic locking and popping of knee |
meniscus injury |
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hx of radiation tx now presenting with volume overload, heart failure |
constrictive pericarditis |
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CV risk >7.5% |
start statins in addition to lifestyle changes |
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dukes criteria |
major: 2+ Blood Cx , +ECHO minor: predisposing risk, fever, vascular, immunologic, abnormal bloodcx / ECHO |
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lymphatic obstruction vs. venous stasis |
lymph: usually malignancy, thickening of skin stasis: better in morning, worse through the day |
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peripheral blood smear |
schistocytes (fragmented RBC) -SS burr cell (serrated) -kidney and liver dz HJ bodies -hx of splenectomy spurr cell -liver disease target -hemoglobinopathies |
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pt with endocarditis who has conduction problems ie. AV block |
concerning for perivalvular abscess |
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painless transient vision loss curtain falling down |
amaurosis fugax can be due to emboli from carotid bruit (seen in fibromuscular dysplasia) |
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HTN, transient vision loss, HA, carotid bruits |
fibromuscular dysplasia
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vesicles on hand Tsanck smear+ for HSV |
herpetic whitlow healthcare workers or women with genital herpes |
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best markers to follow for DKA tx |
anion GAP beta-hydroxbutyrate levels in serum |
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chest pain precipitated by stress/emotion alleviated by nitrates EKG, barium swallow, EGD normal |
diffuse esophageal spasm esophageal manometry study |
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pt with AFIB being tx, shows incr QRS interval during stress test |
use dependence of flecainide use dependence also seen in CCB but you see prolong PR interval instead |
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goes to sandy beach in tropics itchy red papules --> serpiginous reddish brown raised lesions |
cutaneous larva migrans |
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kid stuff laryngotreacheitis (croup) epiglottis bronchiolitis laryngomalacia |
barky cough, stridor, hoarseness hflu, sore throat, high fever, drooling, dysphagia RSV, wheezing, no barky cough worse supine, better laying down, chronic, stridor |
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post-URI nephritis, 5 days after normal complement |
IgA nephropathy |
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post-URI nephritis, 10-12 days after low complement |
post-infectious glomerulonephritis |
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yellow white patches of retinal opacification retinal hemorrhages CD4 <50 |
CMV retinitis |
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gold standard for dx of muscular dystrophy? |
genetic testing muscle biopsy shows fibrosis and fatty infiltrate |
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subQ nodules cafe au lait spots hearing loss +FH |
type 2 NF |
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chronic ear infections tx it but still lots of drainage, some hearing loss granulation tissue / skin debris on exam |
cholesteatoma can be acquired vs genetic complications: hearing loss, CN palsy, vertigo, spread of infection |
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feeding problems big head ID cafe au lait spots |
type 1 NF can develop subq nodules later |
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tx of migraine with n/v |
chlorpromazine, prochlorperazine, metoclopramide |
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1st line migraine prophylaxis |
amitryptaline depakote propanolol topiramate |
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liver cyst with "eggshell calcification" |
buzzword for hydatid cyst tx with albendazole and resection |
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lose pain/temp ipsilateral face, contralateral body CN3, 9, 10 palsies where is infarct? |
lateral medullary infarct (wallenburg) occlusion of PCA or vertebral artery |
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contralateral arm/leg paralysis ipsilateral tongue deviation |
medial medullary infarct branch occlusion of vertebral or ASA |
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motor and sensory of ipsilateral trigeminal nerve jaw weakness, cant chew, cant feel face |
lateral pontine |
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ataxia + hemiparesis (contralateral) |
medial pontine |
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nephritic picture elevated LFTs low complement |
think Cryo from Hep C |
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mets to brain most common? |
lung, breast, unknown primary, melanoma, colon |
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dx of melanoma shave or excisional |
excisional bc want to assess depth of spread |
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jerky movements dementia +FH |
huntingtons caudate nucleas atrophy (see enlarged ventricles) |
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lenticular nucleus atrophy diffuse cerebral cortex atrophy frontal/temporal atrophy |
wilson's alzheimers pick's disease (frontotemporal dementia) |
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diffuse rash everything including palm/soles generalized LAD malaise, fever |
think secondary syphilis |
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signs of liver cirhossis portal HTN hyperestrenism decr hepatic fxn |
varices, HSM, ascites, caput medusa, hemorrhoids spider angiomata, gynecomastia, testicular atrophy, palmar erythema ecchymosis (clotting factors), edema (albumin) |
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atropine pilocarpine |
anticholinergic -incr IOP, dilate cholinergic -decr IOP, constrict |
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most important goal in tx rib fx |
pain management pain = hypoventilation = atelectasis / PNA |
